Factors associated with sickle cell disease severity among patients with sickle cell disease at Webuye County Hospital, Kenya

Abstract

Background: Globally, sickle cell disease (SCD) has its highest prevalence and worst prognosis in sub-Saharan Africa despite the improvements that have been made worldwide in its management and prognosis over the last two decades. An estimated 300,000 children are born with SCD worldwide and three-quarters of these births are in sub-Saharan Africa. There is a high prevalence of sickle cell disease in western Kenya. While some of the patients remain relatively stable, others experience more adverse outcomes and require frequent hospitalizations. Objective: To determine the factors associated with disease severity among patients with Sickle Cell Disease seen in Webuye County Hospital. Methods: This was a descriptive cross-sectional study conducted at Webuye County Hospital inpatient and outpatient departments. The study population consisted of all patients with SCD on follow up and those admitted into the wards during the study period. Using the Fisher’s formula, the minimum sample size was calculated to be 108 but a total of 151 were recruited during the study period. The patients were recruited using consecutive sampling method as they came into the clinic and upon admission into the wards. A pre-structured questionnaire was used to collect socio-demographic and anthropometric data. Blood samples were collected for electrophoresis and haemogram analysis. Disease severity was assessed using sickle cell disease severity index. Data analysis was done using software for data and computing known as R (R Core Team 2015). Association between socio-demographic, healthcare utilization and laboratory characteristics with disease severity was assessed. P<0.05 was considered significant. Results: Results from 151 participant results were analyzed. The median age of participants was 5 years with a minimum and maximum of 1 and 18 years respectively. Males were more represented at 55.6%. The median age at diagnosis was 1.5 years. Eightysix participants had mild disease; Fifty-nine had moderate severity while only six had severe disease. There was no association between the socio-demographic characteristics and disease severity. Patients who attended at least three-quarters of their scheduled clinic visits had a significantly mild course of sickle cell disease. Conclusions: There was no association between socio-demographic, laboratory characteristics and disease severity among our patients. Patients who attend at least threequarters of scheduled follow-up have a mild course of SCD. Recommendations: All patients with SCD in our set up should be sensitized to adhere to prescribed supportive measures with or without SCD crises.